CNM, CPM, Licensed Midwife or Doula? Who Does What
The training, certification and licensing behind each midwifery credential, and how doulas differ.
"Midwife" covers several different professions in the United States, with different training, different licenses and different places of practice. Add doulas, who are not midwives at all, and it is easy to be confused. This guide explains the main credentials you will see on the listings here, what each one means, and how to check it. It is general information, not medical advice.
Certified nurse-midwives (CNM) and certified midwives (CM)
A certified nurse-midwife is a registered nurse who has completed a graduate degree in midwifery and passed a national board exam. A certified midwife has the same midwifery education and exam but is not a nurse. The American College of Nurse-Midwives (ACNM) puts it this way: CMs "differ from Certified Nurse-Midwives (CNMs) only in that they are not also licensed as nurses. CMs and CNMs meet the same core competencies, sit for the same board exam, and have identical scopes of practice including prescriptive privileges" (ACNM: the CNM and CM credentials).
Both require a graduate degree from a program accredited by the Accreditation Commission for Midwifery Education (ACME) and certification by the American Midwifery Certification Board (AMCB) (AMCB). Their scope covers primary and reproductive health care, with an emphasis on gynecologic care, pregnancy and childbirth. CNMs work in hospitals, birth centers, clinics and home-birth practices. The CM credential is recognized in fewer places; ACNM lists Arkansas, Colorado, Delaware, Hawaii, Maine, Maryland, Minnesota, New Jersey, New York, Oklahoma, Rhode Island, Virginia and the District of Columbia.
On this site, individuals who registered as Advanced Practice Midwife in the federal NPI registry, and midwives who list CNM or CM, appear under Certified nurse-midwives. Many also list nurse practitioner credentials such as WHNP (women's health nurse practitioner) or FNP.
Certified professional midwives (CPM) and licensed midwives (LM)
The Certified Professional Midwife credential is issued by the North American Registry of Midwives (NARM). NARM describes it as "the only NCCA-accredited midwifery credential that includes a requirement for out-of-hospital experience," and says it exists to set standards for midwives who practice "predominately in out-of-hospital settings," meaning homes and freestanding birth centers. Candidates qualify through one of several routes, including graduation from a program accredited by the Midwifery Education Accreditation Council (MEAC) or NARM's portfolio evaluation process, and must pass NARM's written exam. CPMs recertify every three years (NARM: certification).
Whether a CPM can practice legally, and under what title, depends on the state. Many states license direct-entry midwives, often using the CPM as the basis, under titles such as Licensed Midwife (LM), Licensed Direct-Entry Midwife (LDEM or LDM) or Registered Midwife (RM). Others do not license them at all. CPMs and licensed midwives generally care for people with low-risk pregnancies and do not have the prescribing authority of CNMs. On the records here, CPM and LM credentials are most common in California, Texas, Florida, Washington and Oregon.
Doulas
A doula is not a midwife and does not deliver babies. DONA International, one of the main training organizations, defines a doula as "a trained professional who provides continuous physical, emotional and informational support to their client before, during and shortly after childbirth" (DONA International). Birth doulas support you through labor; postpartum doulas help in the weeks after birth with feeding, newborn care and recovery. A doula works alongside your midwife or doctor, not instead of one.
Most states do not license doulas, and certification comes from private organizations such as DONA. Some state Medicaid programs now enroll doulas, which is why many have NPIs. This site lists doula organizations and agencies only, not individual doulas, because individual doulas often register a home address.
Birth centers
A freestanding birth center is a health facility, not a hospital, where midwives (and sometimes physicians) care for people with healthy, low-risk pregnancies through labor and birth, with arrangements to transfer to a hospital when needed. Our guide to birth centers explains licensing and accreditation.
How the NPI registry sorts midwives
When a provider applies for a National Provider Identifier, they choose a primary specialty from a national list. Two codes cover midwives: Advanced Practice Midwife, used mostly by certified nurse-midwives, and Midwife, used by certified professional midwives, licensed midwives and some CNMs. Which code someone picked is their own choice, so the credentials they list are often a better guide than the code. That is why this site groups midwives both ways: by registered specialty (Midwives, Certified nurse-midwives) and by the credentials on the record (CNM and CM, or CPM and LM). A midwife can appear in more than one group. Birth centers and doula programs choose their own codes in the same way, and some birth centers registered under a midwifery code appear under Midwifery practices.
What the letters tell you, and what they don't
The credentials shown on each listing are what the provider typed into the federal NPI registry. We tidy the spelling but do not check them. A credential tells you about training; a state license tells you the person may legally practice where you live. Check both:
- For a CNM or CM, confirm the state license (often with the board of nursing) and AMCB certification.
- For a CPM or licensed midwife, confirm the state midwifery license, if your state issues one, and NARM certification.
- For a doula, ask about training, certification and references, and, if Medicaid is paying, whether they are enrolled with your plan.
Which is right for you?
That depends on your health, your pregnancy and where you want to give birth, which is a conversation to have with a qualified clinician. In general, people planning a hospital birth with a midwife will see a CNM; people planning a birth at home or in a freestanding birth center may see a CNM, a CPM or a licensed midwife, depending on the state. A doula can join any of these teams. Whichever you choose, ask how they handle transfers and emergencies, and who covers when they are unavailable.
General information only, current as of the date above. The information on Midwife & Birth Center Index is not medical advice and does not replace a doctor, nurse, discharge planner or other qualified professional. Do not use it to make decisions about diagnosis or treatment. If you have a medical emergency, call 911. Rules and programs change; check the official sources linked in this guide.